Child psychotherapy

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Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. [1] The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members. [1]

Contents

The term, "psychotherapy" includes the implementation of educational and psychoanalytic support for the client and is effective in problem-solving, emotional regulation, and encouraging pro-social behaviors as children develop positive changes to their current mindsets. [1] Terms describing child-focused treatments may vary from one part of the world to another, with particular differences in the use of such terms, as "therapy", "child psychotherapy" or "child analysis"."

Evolution of child psychotherapy

Child Psychotherapy has developed varied approaches over the last century. [2] Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one through the Child Guidance Movement, the other stemming from adult psychiatry or psychological medicine, which evolved a separate child psychiatry specialism. [3]

The separation of child and adult psychology

The attempt to create a unified method of child mental health care led to the increase of child guidance clinics in England throughout the mid-twentieth century. [2] The spread of clinics across Europe coincided with the absence of hospital care as the lack of distinction between child and adult psychiatry prevented further analysis of child diagnosis and treatment. [2] The first Chair of Child Psychiatry officially coined the term, Child and Adolescent Psychiatry in 1973, but it was not until the DSM-III where a full list of distinct child psychiatric disorders were mentioned.

Psychoanalytic child psychotherapy

Psychoanalytic psychotherapy with infants, children and adolescents is mainly delivered by people qualified specifically in psychoanalytic child psychotherapy, or by trainees under supervision from a specialist in child-focused treatment. Recent evidence, [4] covering 34 research papers (nine of which were randomized controlled trials) showed psychoanalytic psychotherapy to be particularly effective for children with the following conditions:

Furthermore, follow-up research [5] shows that in psychoanalytic psychotherapy, therapeutic improvements continue well beyond the termination of the therapy itself. This has been termed a, "sleeper effect."

In the UK, psychoanalytic psychotherapy is recommended by NICE as an evidence-based treatment for trauma from sexual abuse [6] and severe depression in adolescents [7] following the IMPACT study. [8]

Evidence-based child and adolescent psychiatry

There are various therapeutic assessments to address mental health concerns among children and adolescents. Some approaches are backed by strong scientific evidence, while some are not. [9] Some research suggests that it is the quality of the relationship with the therapist, rather than the particular form of therapeutic intervention, that is the strongest factor in helping change develop. [10]

Parent–infant psychotherapy

If the normal course of secure attachment between parent and infant is disrupted, parent–infant psychotherapy is a catch-all term to describe psychotherapies that either aim to restore this bond or to work with vulnerable parents to overcome disruption and prevent further occurrence. Examples of this kind of therapy include, "Watch, Wait, Wonder," and psychoanalytic parent-infant psychotherapy. Many of these techniques require a three-way relationship between the parent, child, and therapist. During therapy sessions, the parent may express his or her thoughts and feelings which are based on a combination of factors including:

  1. The parent's experiences as a child
  2. The parent's expectations and hopes for the child's future
  3. The relationships the parent has with other people

The therapist's role is as an observer and an interpreter of the interaction between the infant and the parent. He might share some of his thoughts about the behavior of the child with the parent and by doing so offering the parent an alternative way of experiencing the child. This technique helps the parent to resolve issues with his or her own infancy-experiences in order to restore secure attachment with the infant. And it helps lower the risk for psychopathological developments of the child in the future. [11] [12]

Group art therapy

Group art therapy gives the child a safe environment to access their emotions through a creative medium in the presence of a therapist. [13] This nonverbal therapeutic practice alleviates the stress that a child may feel when trying to find the words to express themselves; thus it helps rebuild social skills and gain trust in others. Studies have also found that this practice can alleviate self-harm engagement. This method of psychotherapy has been found particularly helpful for children who exhibit any of the following: [13]

Group art therapy has eight subcategories of specific mechanisms of change. Among them are: [14]

  1. As a form of expression to reveal what's inside
  2. As a way of becoming aware of oneself
  3. a way to form a narrative of life
  4. integrative activation of the brain through experience
  5. a form of exploration and/or reflection
  6. the specifics of the art materials/techniques offered in art therapy
  7. as a form to practice and/or learn skills
  8. art therapy as an easily accessible, positive and safe intervention by the use of art materials

By bundling together these specific groups, the general groups are as follows:

Within this approach, three types of behaviors can be exhibited by the therapist; non-directive, directive, and eclectic. [14] Non-directive refers to a following behavior in which the therapist takes on an attitude of observing self-exploration of emotions rather than facilitation or interpretation. Directive attitudes however follow a facilitative pattern by asking specific questions to guide the clients artwork. With these two processes in mind, eclectic combines them to create a facilitative and lenient approach simultaneously and often utilizes emotion check-in's at the start of sessions, and emotion check-outs at the end of sessions.

This approach adopts various psychological elements such as psycho-educational, mindfulness, psychoanalysis, and cognitive analytic theories. This article sought to analyze this methods effectiveness on a broad spectrum, including the following: [15]

Art therapy can be implemented as a holistic therapeutic practice for child cancer patients as well (effecting 1 in 285 children in the US; 15,980 children each year). [16] Given the alleviating effects that are addressed by this method, children were better able to discuss their needs and emotions to their family members and healthcare team. The results of this study conveyed that art therapy lead to improved emotional and mental well-being and improved communication skills.

Parent–child interaction therapy (PCIT)

Parent–child interaction therapy is meant to assist parents whom have children ages 2–7 years old who are prone to disruptive behaviors and emotional difficulties. [17] Parent–child therapy utilizing two stages, each possessing their own goals and characteristics to create this approach. Beginning with child-directed interaction (CDI), parents learn skills such as praise, verbal reflection, imitation, behavioral description, and enjoyment, to achieve the goal of warm and secure parenting styles. Parent-Directed interaction (PDI), the second phase, seeks to decrease the original disruptive behaviors exhibited by the child. Both phases are designed to be coached by the therapist via another room while the parent interacts with their child. This review found that certain cultural values may impede or contribute to the progress of this approach.

Challenges of child psychotherapy

Disregarding suppressed behaviors

Therapeutic interventions among children and adolescents are subject to specific challenges, many of which stem from the reliance of family members as a result of the clients lack of independency at the current stage in their lives. Unlike adult psychotherapy, it is rare for a client to seek treatment themselves in child psychotherapy. [18] The involvement of parents in treatment referral often leads to the frequent disregard suppressed behavioral or emotional problems such as anxiety and depression with the majority of referrals relating to disruptive behaviors. [18]

Lack of motivation

The child-parent dynamic in psychotherapy also has the tendency to increase disagreements regarding treatment processes. [1] Children may be hesitant to accept the idea of undergoing psychotherapy if they were forced into it by a third party. This reluctancy to abide by a psychotherapeutic schedule contributes to the challenge of retaining clients in treatment as 40%-60% of children and adolescents end up dropping out due to demotivation. [18]

Problems of reporting styles

Many challenges associated with child psychotherapy derive from inefficient reports of client symptoms. [1] The methods provided for obtaining information of symptoms typically involve questionnaires and interviews that may affect how the client will answer. [18] Important characteristics of symptoms such as duration and intensity may not be reliable if the client omits crucial information out of fear or risk of embarrassment. [1]

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Reactive attachment disorder (RAD) is described in clinical literature as a severe disorder that can affect children, although these issues do occasionally persist into adulthood. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". In the DSM-5, the "disinhibited form" is considered a separate diagnosis named "disinhibited attachment disorder".

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.

<span class="mw-page-title-main">Play therapy</span> Childrens mental health therapy method

Play therapy refers to a range of methods of capitalising on children's natural urge to explore and harnessing it to meet and respond to the developmental and later also their mental health needs. It is also used for forensic or psychological assessment purposes where the individual is too young or too traumatised to give a verbal account of adverse, abusive or potentially criminal circumstances in their life.

Systemic therapy is a type of psychotherapy that seeks to address people in relationships, dealing with the interactions of groups and their interactional patterns and dynamics.

Dyadic developmental psychotherapy is a psychotherapeutic treatment method for families that have children with symptoms of emotional disorders, including complex trauma and disorders of attachment. It was originally developed by Arthur Becker-Weidman and Daniel Hughes as an intervention for children whose emotional distress resulted from earlier separation from familiar caregivers. Hughes cites attachment theory and particularly the work of John Bowlby as theoretical motivations for dyadic developmental psychotherapy.

Attachment therapy is a pseudoscientific child mental health intervention intended to treat attachment disorders. It is found primarily in the United States, and much of it is centered in about a dozen clinics in Evergreen, Colorado, where Foster Cline, one of the founders, established his clinic in the 1970s.

Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment (EST) that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and that the reverse is also true. It was developed by Gerald Klerman and Myrna Weissman for major depression in the 1970s and has since been adapted for other mental disorders. IPT is an empirically validated intervention for depressive disorders, and is more effective when used in combination with psychiatric medications. Along with cognitive behavioral therapy (CBT), IPT is recommended in treatment guidelines as a psychosocial treatment of choice for depression.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

<span class="mw-page-title-main">Residential treatment center</span> Live-in healthcare facility

A residential treatment center (RTC), sometimes called a rehab, is a live-in health care facility providing therapy for substance use disorders, mental illness, or other behavioral problems. Residential treatment may be considered the "last-ditch" approach to treating abnormal psychology or psychopathology.

Mentalization-based treatment (MBT) is an integrative form of psychotherapy, bringing together aspects of psychodynamic, cognitive-behavioral, systemic and ecological approaches. MBT was developed and manualised by Peter Fonagy and Anthony Bateman, designed for individuals with borderline personality disorder (BPD). Some of these individuals suffer from disorganized attachment and failed to develop a robust mentalization capacity. Fonagy and Bateman define mentalization as the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. An alternative and simpler definition is "Seeing others from the inside and ourselves from the outside." The object of treatment is that patients with BPD increase their mentalization capacity, which should improve affect regulation, thereby reducing suicidality and self-harm, as well as strengthening interpersonal relationships.

Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

Psychodynamic Therapy with Infants and Parents aims to relieve emotional disturbances within the parent(s), the baby, and/or their interaction, for example, postnatal depression and anxiety, infant distress with breastfeeding and sleep, and attachment disorders. It rests on attachment theory and psychoanalysis. Sigmund Freud suggested that a modification of his method could be applied to children, and child analysis was introduced in the 1920s by [Anna Freud].., [Melanie Klein], and Hermine Hug von Hellmuth. Klein speculated on infantile experiences to understand her patients' disorders but she did not practice PTIP. Donald Winnicott, a pediatrician and analyst, focused on the mother-baby interplay in his theorizing and his brief parent-child consultations, but he did not work with PTIP.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

References

  1. 1 2 3 4 5 6 Bhide, Ajit; Chakraborty, Kaustav (2020). "General Principles for Psychotherapeutic Interventions in Children and Adolescents". Indian Journal of Psychiatry. 62 (8): S299–S318. doi: 10.4103/psychiatry.IndianJPsychiatry_811_19 . ISSN   0019-5545. PMC   1347 . PMID   32055072.
  2. 1 2 3 Barrett, Susan (2019). "From Adult Lunatic Asylums to CAMHS Community Care: the Evolution of Specialist Mental Health Care for Children and Adolescents 1948-2018". Revue Française de Civilisation Britannique, XXIV-3. XXIV (3). doi: 10.4000/rfcb.4138 .
  3. John Stewart (2012). "The dangerous age of childhood: child guidance in Britain c. 1918–1955" . Retrieved 9 January 2020.
  4. Midgely, N.; Kennedy, E. (2011). "Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base". Journal of Child Psychotherapy. 37 (3): 232–260. doi:10.1080/0075417X.2011.614738. S2CID   28367786.
  5. Bateman, A.; Fonagy, P. (2001). "Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up". American Journal of Psychiatry. 158 (1): 36–42. doi:10.1176/appi.ajp.158.1.36. PMID   11136631.
  6. "Therapeutic Interventions after Abuse and Neglect – Guidance 76". National Institute for Health and Care Excellence. HM Government. 9 October 2017.
  7. "Therapeutic Interventions for Moderate to Severe Depression – Guidance 28". National Institute for Health and Care Excellence. HM Government. 26 September 2005.
  8. Goodyer, I. M.; Reynolds, S.; Barrett, B.; Byford, S.; Dubika, B.; Hill, J.; et al. (2017). "Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial". Lancet Psychiatry. 4 (3): 109–119. doi:10.1016/S2215-0366(16)30378-9. PMC   5285447 . PMID   27914903.
  9. APA Task Force on Evidence-Based Practice with Children and Adolescents (2008). Disseminating Evidence-Based Practice For Children & Adolescents: a systems approach to enhancing care. Washington, DC: American Psychological Association.
  10. Sutton, S. (2014). Being Taken In: The Framing Relationship. London: Karnac.
  11. Lieberman, AF (1992). "Infant-parent psychotherapy with toddlers". Development and Psychopathology . 4 (4): 559–574. doi:10.1017/s0954579400004879. S2CID   145171277.
  12. Lieberman, AF; Silverman, R; Pawl, JH (2000). "Infant-parent psychotherapy". In Zeanah, CH (ed.). Handbook of infant mental health (2nd ed.). New York: Guilford Press. p. 432. ISBN   1-59385-171-5.
  13. 1 2 Waller, Diane (April 2006). "Art Therapy for Children: How It Leads to Change". Clinical Child Psychology and Psychiatry. 11 (2): 271–282. doi:10.1177/1359104506061419. ISSN   1359-1045. PMID   17086689. S2CID   8241451.
  14. 1 2 Bosgraaf, Liesbeth; Spreen, Marinus; Pattiselanno, Kim; Hooren, Susan van (2020). "Art Therapy for Psychosocial Problems in Children and Adolescents: A Systematic Narrative Review on Art Therapeutic Means and Forms of Expression, Therapist Behavior, and Supposed Mechanisms of Change". Frontiers in Psychology. 11: 584685. doi: 10.3389/fpsyg.2020.584685 . ISSN   1664-1078. PMC   7578380 . PMID   33132993.
  15. Cohen-Yatziv, Liat; Regev, Dafna (3 July 2019). "The effectiveness and contribution of art therapy work with children in 2018 -what progress has been made so far? A systematic review". International Journal of Art Therapy. 24 (3): 100–112. doi:10.1080/17454832.2019.1574845. ISSN   1745-4832. S2CID   151138642.
  16. Aguilar, Bree A. (1 September 2017). "The Efficacy of Art Therapy in Pediatric Oncology Patients: An Integrative Literature Review". Journal of Pediatric Nursing. 36: 173–178. doi:10.1016/j.pedn.2017.06.015. ISSN   0882-5963. PMID   28888499. S2CID   1784960.
  17. Lieneman, Corey C.; Brabson, Laurel A.; Highlander, April; Wallace, Nancy M.; McNeil, Cheryl B. (20 July 2017). "Parent–Child Interaction Therapy: current perspectives". Psychology Research and Behavior Management. 10: 239–256. doi: 10.2147/prbm.s91200 . PMC   5530857 . PMID   28790873.
  18. 1 2 3 4 Kazdin, Alan E. (February 2003). "Psychotherapy for Children and Adolescents". Annual Review of Psychology. 54 (1): 253–276. doi:10.1146/annurev.psych.54.101601.145105. ISSN   0066-4308. PMID   12185210.